Screening and Early Detection

In many cases, prostate cancer doesn’t cause any symptoms until the disease process is in its later stages. For that reason, annual screening exams are a critical component to diagnosing the disease early. Early diagnosis allows a wider variety of treatment options, as well as a chance to stop the disease from spreading elsewhere in the body. The American Cancer Society and the American Urological Association encourage men to talk to their doctor about the risks and benefits of prostate screening. Included in this discussion should be factors that increase risks for prostate cancer such as age, family history and race.

There are two steps to the yearly screening process: a Prostate Specific Antigen (PSA) blood test which measures a protein produced by the cells of the prostate, and a Digital Rectal Exam (DRE) performed by your physician. These tests help identify if there are changes in the size or texture of your prostate, as well as if the prostate is releasing higher than usual amounts of PSA into your blood stream.

PSA is a protein that is naturally produced by the prostate gland. As the prostate enlarges, additional PSA is produced and seeps into the blood stream, making it a useful marker for prostate cancer. While a high PSA doesn’t necessarily mean cancer is present, and a low PSA doesn’t necessarily mean there is no cancer, it is an important tool for physicians. Only a biopsy can confirm or deny the presence of prostate cancer.

If the DRE and/or PSA come back irregular, it may indicate a problem with your prostate, and your physician will want to do additional tests. However, it does not necessarily mean you have cancer, as other prostate problems, such as an infection or an enlarged prostate known as benign prostate hyperplasia can also cause in increased PSA count. Your physician may further evaluate your prostate using ultrasound and biopsy to obtain a tissue sample to check for the presence of cancerous cells in the prostate. For more information on the screening and diagnosis of prostate cancer, see Prostate Cancer: Screening and Diagnosis.

If prostate cancer is diagnosed, the patient’s disease is “staged” according to international standards based on the TNM Scale (Tumor, Nodes and Metastases). This helps gauge the severity of the disease and determine what treatment options are appropriate.

In Stage T1, the tumor is confined to the prostate gland, and is undetectable by DRE. Stage T2 tumors are also confined to the prostate gland, but they are detectable by DRE. T3 tumors have spread from the prostate gland to surrounding tissues, including seminal vesicles. T4 tumors have spread outside of the prostate gland and into nearby organs, such as the bladder.

Nodes refer to the lymph node system, and indicates whether the cancer has spread to the lymph system (N+) or not (N0). Metastases are when the cancer has spread to distant parts of the body, such as the liver, brain or bones. M+ indicates that there are metastases (also known as “mets”), while M0 indicates that there is no evidence of metastases. For a more detailed overview of staging, please see Prostate Cancer Stages or Staging.

Each prostate cancer is also given a “grade,” known as a Gleason Score. This is determined by the pathologist who looks at the cancer cells within the tissue sample. For each area, the pathologist determines how aggressive the cancer appears, with 1 being the least aggressive and 5 being the most aggressive.

The Gleason score is the sum of the two most prominent Gleason patterns in the sample, with the most prominent score reported first. So, a Gleason score of 3+4 = 7 indicates a moderately aggressive cancer as the dominant pattern, with a slightly more aggressive cancer as the less dominant pattern. And, while the sum would still be 7, a 4+3 = 7 Gleason score would indicate a more aggressive prostate cancer than a 3+4=7. While this can be very confusing, it is very important to understand what your Gleason Score is and how it will impact your treatment options and your chance of reoccurrence. For a more detailed overview of Gleason, please see Gleason Grading of Prostate Cancer.

IF YOU NEED HELP: If you are uninsured, unable to qualify for Medicaid or Medicare, and unable to afford your annual prostate screening, please contact Riverside’s Cancer Outreach Office for assistance. Free prostate screenings are offered every fall at various locations throughout the health system by appointments made through the Cancer Outreach Office. For more information on these annual screenings please call (800) 520-7006.

Causes and Risk FactorsAge, race, family history and diet can all influence a man’s risk of developing prostate cancer. Specifically, risk for developing prostate cancer increases with age, going up significantly after age 50, and African-American men have a higher risk of developing the disease than men of other races. For more information, see Prostate Cancer: Risk Factors.